COMPARISON OF PNEUMATIC AND EMS SWISS TRILOGY LITHOTRIPSY IN CONVENTIONAL PERCUTANEOUS NEPHROLITHOTOMY

Abstract

Background: Renal calculi are a significant urological burden globally, with percutaneous nephrolithotomy (PCNL) being the treatment of choice for large stones. Intracorporeal lithotripsy is a critical step during PCNL, where pneumatic and EMS Swiss LithoClast Trilogy are commonly used. Although several studies have compared these modalities internationally, data on their efficacy and safety within local clinical settings remain limited. This study was undertaken to address this gap and provide evidence-based guidance for urologists in resource-constrained regions.

Objective: To compare the stone-free rate and complication profile of pneumatic lithotripsy and EMS Swiss LithoClast Trilogy in patients undergoing conventional PCNL.

Methods: This descriptive comparative study was conducted at the Department of Urology, Lady Reading Hospital, Peshawar, from January 16 to July 15, 2021. A total of 122 patients aged 18–45 years with renal stones were enrolled. Participants underwent conventional PCNL with stone fragmentation using either pneumatic lithotripsy (n = 70) or EMS Trilogy (n = 52), based on clinical parameters. Outcomes were assessed in terms of stone-free rate on CT KUB at 2 weeks and complications graded by Clavien-Dindo classification. Data were analyzed using SPSS version 26, and a p-value ≤0.05 was considered significant.

Results: The mean age in the pneumatic and EMS groups was 32.78 ± 10.34 and 33.84 ± 12.05 years, respectively. Mean stone size was 16.21 ± 5.58 mm in the pneumatic group and 17.68 ± 6.29 mm in the EMS group. Stone-free rate was 84.7% with pneumatic lithotripsy and 74.0% with EMS Trilogy (p = 0.143). Grade IV complications were seen in 19.4% (n = 14) of the pneumatic group and 30.0% (n = 15) of the EMS group (p = 0.530).

Conclusion: Both pneumatic lithotripsy and EMS Swiss Trilogy are effective and viable intracorporeal modalities for stone fragmentation in conventional PCNL, showing comparable outcomes in terms of efficacy and safety.